Wednesday, October 3, 2012

Shock and sucking chest wound at the site of an accident

***A portion of this post appeared previously on Crime Scene Writer.(Link at end of post)

A passerby comes upon an accident. The victim is in shock and has a sucking chest wound.What can be done by a layman armed only with a first aid kit and good intentions?

The Good Samaritan is alive and well and willing to risk a lawsuit to provide aid.

The first weapon in your arsenal is a cell phone. Call 911, then administer first aid.
Shock in this case would most likely be due to blood loss. The damage causing the majority of the bleeding is going to be internal. If the victim is breathing, compressing the wound to stop external bleeding is about all you can do.

Elevating the victim’s feet will keep the blood central, where it will do the most good. Keeping him/her warm by covering the torso will help conserve body heat.
Now for the sucking chest wound.
I’m going to make a leap here and assume you mean a tension pneumothorax. With our accident victim, air enters the chest—it's “sucked” in, but doesn’t exit. This generally happens when air leaks from the damaged lung into the chest, but can’t exit. This so-called “free air” takes up space, and leads to collapse of the lung on that side. The more air that leaks into the chest space and is trapped there, the worse things become.
The treatment is to get the air out. Depending on what you have in your first aid kit (and glove compartment) there are a few options.

First, seal the wounds on the outside of the chest. With penetrating trauma, this means entry and exit wounds. Doing this prevents air from entering from the outside.

Next, look at the patient’s neck—are the neck veins standing out? Normally they wouldn't be, especially in shock. Is the trachea (the breathing passage in the front of the throat). Normally, it should be straight up and down. If it's shifted to the side opposite the wounded side of the chest, this is a sign of pressure in the chest.

The air must be evacuated. In an emergency, a needle between the ribs will let the air out. Inserting the needle will give the trapped air an exit. This is a favorite TV scenario, but it's right on the money as far as a first step.

If no needle is available, any small tube will do. In a MacGyver moment, you can make a hole between the ribs with a pocket knife, and use a pen (take out the innards) and use this as a tube. A drinking straw will work, but is harder to keep from collapsing.
By this time, hopefully the sweet music of an approaching ambulance will fill your ears, as you did the right thing and called 911 first.

Crime Scene Writer is a forum for asking and answering crime scene investigation, applied forensics, and police procedure questions for fiction or non-fiction writers.
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Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Not sure where to post this, but I am a writer, wondering if someone has a stroke and is comatose and ventilated, could they have normal brain activity?

    1. Hello, Holly.
      This is a fine place to post this!
      If someone has a stroke and becomes comatose, their EEG (Brain wave activity measured by the pattern of electrical impulses coming from the brain) won't be normal. Diffuse slowing is usually noted.
      If the patient doesn't react to stimuli, like pain, cold water in the ears, chances are you're looking at a very poor prognosis.
      Coma of any source has abnormal brain activity--after cardiac arrest, for exaple, where the brain can be damaged by lack of oxygen until circulation is restored.
      The ventilator can be for many reasons: the patient who doesn't breathe on his/her own; sedation given for seizures or agitation; severe brain injury.
      Sometimes in electing to withdraw life support the ventilator is removed. Some patients will breathe on their own as breathing is a brainstem function, not a cerebral "Gray Matter" function.
      I'll try to get in touch with you, but if not, I'll post this as a question over the weekend.
      Cheers, Kelly